Black Women Most Likely To Experience Biopsy Delays After Abnormal Mammogram
Women from various racial and ethnic backgrounds were more likely than white women to experience delays in having a biopsy after an abnormal mammogram, with Black women experiencing the most delays, according to a study.
The research was published online on June 23, 2022, by the journal JAMA Oncology. Read the abstract of “Multilevel Factors Associated With Time to Biopsy After Abnormal Screening Mammography Results by Race and Ethnicity.”
Why timely biopsies are important
Screening mammograms help doctors find breast cancer early, when it may be easier to treat. If a mammogram finds a suspicious area, doctors almost always recommend more tests, which may include a biopsy — a small operation to remove tissue from the area of concern.
Most doctors recommend having a biopsy within 30 days of an abnormal mammogram. If the abnormality is cancer, waiting longer may allow the cancer to grow larger or spread to the lymph nodes. Delays also can heighten any anxiety and fear a person might be feeling about what the abnormal mammogram may mean as well as about the biopsy procedure.
Several studies have reported that women of certain racial and ethnic backgrounds, including Black, Asian, and Hispanic women, are more likely to experience delays in diagnosis and treatment after an abnormal mammogram.
Other research has shown that certain factors are linked to diagnosis and treatment delays after an abnormal mammogram, including:
race and ethnicity
Still, these studies included people who were very similar, people from only one area, or people who all have Medicare health insurance. So, it’s been difficult to truly figure out how much neighborhood socioeconomic status and healthcare factors can cause delays in care after an abnormal mammogram.
About the study
To help pinpoint how much neighborhood and healthcare factors can cause treatment delays after an abnormal mammogram, the researchers in this study analyzed information from seven Breast Cancer Surveillance Consortium registries:
Carolina Mammography Registry
Kaiser Permanente Washington Registry
Metro Chicago Breast Cancer Registry
New Hampshire Mammography Network
Sacramento Area Breast Imaging Registry
San Francisco Mammography Registry
Vermont Breast Cancer Surveillance System
The Breast Cancer Surveillance Consortium is a collaborative network of breast imaging registries focused on research to assess and improve the delivery and quality of breast cancer screening and related outcomes in the United States.
In total, the researchers analyzed 46,185 screening mammograms with abnormal results from 45,186 women done at 109 facilities.
The women ranged in age from 48 to 65 and most self-identified as white:
65.1% were white
13.5% were Black
12.2% were Asian
6.6% were Hispanic
2.6% were from other racial and ethnic backgrounds, including Alaska Native, American Indian, Native Hawaiian, Pacific Islander, or two or more races or ethnicities
White women were much more likely to live in a neighborhood where more than 75% of the people had a high school education. The researchers found that:
19.7% of Hispanic women lived in a neighborhood where no more than 75% of the people had a high school education
19.6% of Asian women lived in a neighborhood where no more than 75% of the people had a high school education
10.4% of Black women lived in a neighborhood where no more than 75% of the people had a high school education
7% of Alaska Native, American Indian, Native Hawaiian, and Pacific Islander women and women of two or more races or ethnicities lived in a neighborhood where no more than 75% of the people had a high school education
2.6% of white women lived in a neighborhood where no more than 75% of the people had a high school education
Among the 46,185 abnormal mammograms:
34.6% were not resolved within 30 days
16.2% were not resolved within 60 days
12.2% were not resolved within 90 days
When the researchers said that an abnormal mammogram wasn’t resolved, they meant no biopsy was done.
Overall, half the women had a biopsy less than 23 days after an abnormal mammogram, and half had a biopsy more than 23 days after an abnormal mammogram.
The number of days from abnormal mammogram to biopsy by racial or ethnic group was:
20.7 days for white women
30.3 days for Asian women
29.3 days for Black women
26.9 days for Hispanic women
Using the number of days from abnormal mammogram to biopsy for white women as a benchmark, the researchers found that 30 days after an abnormal mammogram:
Asian women had a 66% higher risk of not having a biopsy
Black women had a 52% higher risk of not having a biopsy
Hispanic women had a 50% higher risk of not having a biopsy
Using the same benchmark, the researchers found that 90 days after an abnormal mammogram:
Black women had a 28% higher risk of not having a biopsy
Asian women had a 21% higher risk of not having a biopsy
Hispanic women had a 12% higher risk of not having a biopsy
When the researchers factored in neighborhood characteristics, this increased risk didn’t change much. But when the researchers factored in the differences in screening facilities, the risk of delays were lower.
The researchers considered the following differences in screening facilities:
type of screening mammogram (2D, 3D, or film)
whether the facility had an affiliation with an academic institution
whether the facility had on-site biopsy services
Still, it wasn’t clear which differences affected the number of days from abnormal mammogram to biopsy.
“Even after adjusting for multiple factors thought to contribute to delayed diagnosis, we still see persistent disparities among minority women, particularly Black women,” Marissa Lawson, MD, lead author of the study and acting radiology instructor at the University of Washington School of Medicine, said in a statement. “To me, this suggests that other underlying factors are contributing to these differences in time to biopsy.
“Controlling for individual- and neighborhood-level factors, we saw that risk was not very different from the unadjusted model,” Dr. Lawson continued. “But when we controlled for the screening facility attended, delays in time to biopsy were reduced. The findings indicate that there are some differences among the screening facilities associated with the time to biopsy. We just don’t know what the specific differences are.”
The researchers suggested that structural healthcare system factors may be the cause of the differences in the number of days from abnormal mammogram to biopsy among the various racial and ethnic groups. These factors could include:
how the facility communicates with patients
ease of scheduling a biopsy
whether translators are available
What this means for you
If your mammogram results were abnormal, it makes sense to talk to your doctor about next steps, including whether you should have more imaging or a biopsy. If your doctor recommends a biopsy, research strongly suggests that having the procedure within 30 days of the abnormal mammogram can lead to better outcomes.
If you’re finding it hard to schedule a mammogram because of language or other communication barriers, you may want to ask a social worker or patient navigator at your facility if you can work with a translator or other person who can help you.
If you’re under-insured or unemployed and worried about paying for the biopsy, there are resources that can help. Your doctor’s office may be able to give you a list of organizations that offer financial assistance for breast cancer care. Triage Cancer is a nonprofit organization that offers legal and financial advice to people affected by cancer.
There is only one of you and you deserve the best care possible, delivered in a timely manner. No obstacles should ever get in the way of your treatment.
Learn more about Covering the Costs of Your Breast Cancer Care.
Written by: Jamie DePolo, senior editor
— Last updated on July 17, 2022, 7:18 PM